new paradigm in imolant dentisrtry??????

[adwait]

please all experts and course conductors explain after watching the opg attached
is there a new paradigm of stabilising failing implant with failing abutments
what makes so called implantologists to do such things

        

[Anonymous]

this is unethical.

I feel that if an implant is failing it should have been treated by various modalities Guided bone regeneration) available and even than if it is failing than the implant should be removed . After healing the implant should be placed once again.

All implant patients should be monitored at regular intervals and the bone level around implants should be assessed by radiographs so that any problems are detected early.

Veerendra Darakh

        

[Anonymous]

this is a shame to the ethics of the practitioner responsible. , ,. even i am of the view that implant insertion requires thorough assessment of various bone and other parameters and planning prior to the procedure ., ,. and then regular 6 monthly check-up visits are a must too . ,. ,

        

[Anonymous]

I can tell that this is the result when everybody tries to place implants. This is a high-time where the need for intense training, and exposure can be felt

        

[sushantpatel_doc]

Implants are becoming a progressive trend amongs the patients as well…the no of patients demanding implants have increased…so in my view its high time implantology should be included in the undergraduate curriculum…otherwise it’ll lead to many such failures..

        

[Anonymous]

anyway Dr.Adwait what was the presenting symptoms of the patient and what was done about it.

any followup.

Regards,

Veerendra Darakh

        

[sushantpatel_doc]

Ya Dr. Adwait..we would like to know the follow up of the case…

        

[adwait]

sorry docs since i was out of the town and busy with some medical emergencies , i could not reply to you.
well getting back to the topic , the patient had presented to me obvously with the mobile unit of the bridge .
after doing all the examinations it was quite obvious that i have to remove all.
To my surprise it was just a job of10 min to get everything and implant.
site was deeply curetted till i could see the fresh bone without granulation.
Obviously patient has lost hope with the implant therapy .
He says “THIS IS THE NEW TOOL OF DENTISTS TO DIG OUT MONEY FROM OUR POCKET,I WOULD RATHER GO FOR COMPLETE DENTURE THAN TO FOR SUCH EXPERIMENTS”
Although the patient is over reacting but this would be senario if we are not cautious to perform concious effort to perform any procedure in dentistry.THE SCIENCE WIILL BE BLAMED FOR THE FAULTS OF THE OPERATOR

        

[drmithila]

Scandals, lawsuits, a growing focus on commercialization and self-promotion, and dentists who prescribe excessive treatments are tarnishing the profession’s image, according to a presentation on ethics at the recent ADA annual session in Las Vegas.

Most dentists may be surprised that a Google search on ethical scandals among health professions shows that dentistry now gets more hits than medicine, nursing, chiropractics, and pharmacology, according to Ann Boyle, DMD, interim provost and vice chancellor for academic affairs at Southern Illinois University.

Some of the public’s changing perceptions toward dentistry can undoubtedly be traced to ubiquitous media coverage of scandals and malpractice lawsuits involving medical professionals, Dr. Boyle noted.

Gordon Christensen, DDS, MSD, PhD, discussed the decline of dentists’ credibility in a 2001 article, noting a Gallup poll showed that their ranking among professions had fallen below nurses, physicians, and veterinarians (Journal of the American Dental Association, August 2001, Vol. 132:8, pp. 1163-1165).

Dentists were ranked third among the most trusted professionals in 1995 but slipped to ninth in 2001, according to Gallup poll rankings; they ranked sixth in 2009.

Negative influences, according to Dr. Christensen, included commercialization and self-promotion, excessive treatment and fees, providing service only when it’s convenient, and refusing to accept responsibility when treatment fails prematurely.

“These front-line physicians consider us uncaring, selfish, greedy, and unprofessional.”
— Ann Boyle, DMD, Southern Illinois
University
Dr. Boyle pointed to a 1997 Reader’s Digest article about dentists’ honesty. In it, the author visited 50 dentists in 28 states to see how many different treatment plans he would get.

Before the survey, the author had exams and plans from his own dentist and three others who participated in the investigation. All determined that one tooth needed a crown. But the 50 treatment plans he received ranged from three dentists who said he needed no treatment to a recommendation for 21 crowns and six veneers at a cost of nearly $30,000.

“Whether we like it or not, this article clearly left the impression that some of us were planning excessive care and could not be trusted,” Dr. Boyle said.

Dentists who charge high fees without justification were also excoriated by Dr. Christensen. “It is our professional responsibility to provide oral care services at a level of efficiency that allows us to treat most of the patients who request our services, including some patients without the ability to pay,” he said. “If all of us treated only those who could pay high fees, we would not fulfill our responsibility as members of a profession.”

Dr. Boyle recalled hearing from frustrated emergency room doctors who complained that they cannot adequately treat dental emergencies and said many patients come to them because no dentist will see them.

“We know there are reasons for this that MDs don’t understand,” she said, “but we must also realize that these front-line physicians consider us uncaring, selfish, and greedy and unprofessional and will tell anyone who will listen, including politicians.”

Cheating in dental schools

Dr. Boyle also discussed the growing prevalence of cheating among dental students. In 2006 and 2007, cheating incidents at five dental schools became public, including instances involving patient care. And a 2007 survey in the Journal of Dental Education found that 75% of dental students admitted to cheating on exams, she said (August 2007, Vol. 71:8, pp. 1027-1039).

Cheating methods range from using new technology — using smartphones to look up answers, texting, and using cellphone cameras to capture exams for later reconstruction — to old tricks such as crib sheets hidden on thighs, the underside of caps, and on oversized erasers, Dr. Boyle said. One imaginative cheater peeled off the label of a water bottle, wrote answers on it, then replaced it on the bottle. The result was a magnified version of the information he was able to read during the test.

“Everybody has to empty their pockets before tests now, like airport security,” Dr. Boyle told the gathering.

Students have even performed unnecessary procedures, including root canals, to fulfill requirements, she noted. Forging faculty signatures for clinical work is another ploy. Online sites sell admission essays, including papers on dental ethics, Dr. Boyle wryly added.

A recent survey of ethics instructors at 56 U.S. dental schools revealed that “little time is devoted to ethics instruction in the formal curriculum” (Journal of Dental Education, October 2011, Vol. 75:10, pp. 1295-1309).

While the amount of time devoted to ethics instruction appears not to have changed much over the past 30 years, “what has changed are what qualifies as ethics instruction, the pedagogies used, and the development and availability of norm-referenced learning outcomes assessments, which are currently used by a number of schools,” wrote the study authors, from the University of Michigan.

Ethics need to be more fully integrated across the dental school curriculum, including carryover into the clinical years, and assessing and ensuring competence also is needed, the researchers concluded.

        

[Drsumitra]

Researchers of Castelló and Basque Country develope a biodegradable coating which quickens and widens compatibility of tooth implants

Elderly or people with osteoporosis, smokers, diabetics or people who have had cancer are sometimes not eligible to receive dental implants due to the lack of ability of their bones to integrate in a proper way the new prosthesis which replace the root. The coating of implants with a novel biodegradable material, developed by researchers at the Universitat Jaume I, University of the Basque Country and the company Ilerimplant, will allow perform implants in people with bone deficit, while increasing the overall success rate of implants through an enhanced biocompatibility and reduce the time of osseointegration, i.e. the bone integration.

If so far the titanium radicle replacing the tooth root took to be anchored to the jawbone at least two months, the prototype developed will reduce the time so that patients can receive before the ceramic crown, which replaces the visible part of the tooth, and thus regain their normal life before. Julio José Suay, coordinator of the research group of Polymers and Advanced Materials of the UJI explains "it consists on covering the implant with a biodegradable coating that, upon contact with the bone, dissolves and during this degradation process is able to release silicon compounds and other bioactive molecules which induce bone generation".

This is a totally innovative research line for the systems used to date, which consists of increasing roughness of implants to facilitate its integration into the bone. In this regard, Suay stresses that Soldent is a collaborative project between academia and industry developed in the framework of the call “Innpacto” of the Spanish Ministry of Economy and competitiveness. “What is sought is to achieve a high level of innovation to favour that research centres and companies work closely together. From the needs detected by companies, in this case by patients, researches are redirected and in this way are achieved disruptive innovations, which are not in markets and which open new business opportunities", he says.

For the Soldent project, researchers at the Jaume I and the University of the Basque Country are working together with the company Ilerimplant SL in the competitive development of this prototype. After in vitro testing with cell cultures of the different biomaterials prepared, we proceeded to the live animal evaluation, until achieving the prototype with the best results. In a new phase, Suay explains that will be done the clinical evaluation, in order to obtain the marketable sanitary product within two or three years.

The research aims to encourage the success rate of dental implants, especially those made on people that may have deficiencies in their jawbone. In this regard, it is noted that non-replacement of a lost tooth involves a series of biomechanical problems such as change of the bite line, the disordering of the teeth and the creation of empty spaces between them, which ultimately can lead to periodontal diseases as gingivitis and periodontitis deteriorating clamping mechanisms of the teeth and cause the loss of more teeth. Herein lies the importance of replacing the teeth, in addition to the full recovery of the masticatory functions and normal social relations.

Dental prosthesis replacing natural teeth are composed of a titanium root prosthesis, which replaces the tooth root and to be anchored to the jawbone, and the ceramic crown, which replaces the visible part of the tooth. The root prosthesis should be anchored to the bone enough before applying mechanical load on it, which means that to date it is needed over a minimum of eight weeks to incorporate the crown. The coating obtained accelerates the anchor period, so that the crown can be placed before, also avoiding the risk of infection during this time.

Video: http://blogs.uji.es/cienciatv/

Publications:
– M. Hernández-Escolano, M. Juan-Díaz, M. Martínez-Ibáñez, A. Jimenez-Morales, I. Goñi, M. Gurruchaga &J. Suay “The design and characterisation of sol–gel coatings for the controlled-release of active molecules” Journal of Sol-Gel Science and Technology DOI 10.1007/s10971-012-2876-6

– M. Hernández-Escolano, X. Ramis, A. Jiménez-Morales, M. Juan-Díaz, J. Suay "Study of the thermal degradation of bioactive sol–gel coatings for the optimization of its curing process” J Therm Anal Calorim DOI 10.1007/s10973-011-1553-2

 

        

[drmithila]

The article was written by:
Prof. Mauro Labanca
Today, about 65 % of Italian dentists are prac tising implantology. In Italy alone, over a million implants are placed every year. A survey commissioned by the Italian Society of Osseointegrated Implantology on implant perception among the Italian population found that 68 % of the respondents would request an implant should the need for an artificial tooth arise.
One Italian out of three has undergone oral implant surgery. It follows that osseointegrated implants will be offered by a growing number of professionals and be placed in an ever-larger population in the future.[1]
It should also be noted that the economic crisis has severely affected even the dental field, and the repercussions of this phenomenon have been reported by newspapers, professional associations and the Ministry of Health in Italy. The Osservasalute report, an overview of health in Italy (compiled by the National Observatory on Health Status in the Italian Regions, based at the Universita Cattolica del Sacro Cuore’s campus in Rome), reported in 2010 that Italians are being forced to save and that both the food and dental industries will suffer as a result.[2]
Past president of the Italian National Association of Dentists (ANDI) Dr Roberto Callioni analysed the consequences of the economic crisis and future prospects at a conference held under the auspices of the Ministry of Health on 29 March 2011. He stated that, according to a survey by ANDI in 2010, 30 % of Italian dentists have less work because of the crisis.[3]
However, he also observed an increase in offerings owing to the extension of retirement age and the number of graduates, and a decline in demand related to the decrease in purchasing power, a decline in birth rate and a decrease in the DMFT index.[3]

In addition, dentists have to compete against low-cost dental offers and dental tourism to some locations in Eastern Europe (as was the case in the 1990s with regard to the Netherlands). The increase in offerings and the reduction in demand have resulted in the average practitioner having higher costs and lower revenues, also owing to the instability of supply and demand. Oral implantology is affected, as are other disciplines of dentistry, by the current socio-economic situation. Yet, the sense is that of a greater demand by the public and a need for the dentist to offer treatment at a lower cost.
In Italy, there are more than 300 different implant systems (probably not an accurate estimate, considering the difficulty in recording copies of copies). These systems usually have the certification necessary for the market, but only a small proportion of them are supported by scientific evidence, based on studies appropriately designed and conducted by independent research institutions, attesting to their clinical performance, especially in the long term and with the proper follow-up. These are the considerations that, together with the lack of reference measure for quality, led the Italian Society of Osseointegrated Implantology to or ganise the quality forum in implantology, held in Verona from 15–17 November 2008, in which a large number of experts analysed the various aspects of quality in implantology.
The selection of an implant system suited to the demands of the professional is strongly felt to optimise costs when trying to increase profits where possible without interfering with the quality delivered. As written by Pierluigi La Porta in the context of the forum of quality in implantology[4]:
The professional liability requires that the professional has all the factors of production under his control by deploying useful tools to measure the quality of his works, the results that follow and the tools used to achieve performance. Moreover, the information asymmetry that characterizes the doctor-patient relationship is known in the health field, making patients entrust themselves to the professionals’ decisions in order to solve their health problem. This assignment essentially denotes the inability of the patient to decide what is really best to do in that situation, even if he is well informed. His expectations are related to the solution of the problem, but he rarely pays attention to the way it is resolved or the instruments used, so the professional is solely responsible. The case law indicates the responsibility of the doctor to “act like a good father” when he is the one to decide for his patient. So be sure that the quality of his performance becomes a must of his action. When professionals begin to question the quality of their performance, then you are facing a true and profound cultural change.
To these considerations, one might add: why would a patient choose to seek treatment in a dental centre?
“The dentist? A mechanic who changed parts of your car but, not being technical, you never know if you’re rubbing or not.”
This in how one interviewee responded to the request by the well-known psychologist and professor of marketing and communication Alberto Crescentini to describe the figure of the dentist.[5] The average patient finds it difficult to evaluate the quality of a medical service from a technical point of view because he simply does not have the skills. It is our duty not to betray him, and act according to the science and our knowledge. Bearing this all in mind, we should determine the possible savings in the management of implants and whether buying an implant at a lower cost will sult in cost effectiveness. To quote Charles Darwin:
“It is not the strongest species that survive, nor the most intelligent, but the ones most responsive to change.”[6]
In the literature, there are various articles about implant placement techniques, biomaterials and loading protocols, but there is only very little in formation about cost analysis in relation to implant-prosthetic procedures.
Questions regarding the cost of implant placement and the amount a dentist can earn by placing fixtures tend not to be discussed at congresses, as if in fact the one and only important aspect is the finalisation of the case. In a country like Italy, where dentistry is largely private, the economic aspects are fundamental for the acceptance of the treatment plan by the patient. Even in ethical terms, if the dentist believes that his implant is really the most appropriate solution for that particular case, prohibitive costs could deprive the patient of that possible solution or push him towards other choices, both operational (other restorative solutions) and logistic (low-cost dentist or travel to a dentist abroad).
As observed earlier, there are over 300 different types of implants in Italy. Conventionally, these are divided into classes based on various aspects, one of which is purchase price. We could argue, however, that all implants are osseointegrated in the end and that implants that are more expensive are simply more advertised, but in essence they are the same as others. In Italy, many “homemade” and low-cost implant systems are available on the market whose traceability is practically absent in the literature and whose manufacturers are not able to guarantee long-term reliability.[7] If we evaluate the sales data of the leading implant-producing companies, eight to ten leading companies hold 90 % of the existing market share. As a logical consequence, the remaining 10 %, amounting to approximately 100,000/150,000 units, can be divided among the remaining 300 or more companies on the market. What can the average number of implants sold by each of these be (despite what their dealers tell dentists)? Are they supported by case studies or other scientific literature? We should not forget that the intervention of implantation entails placing a foreign object, even if this is made of titanium, into the mouth of a patient, hopefully for life, and with undeniable biological effects. In order to do this in a verified and ethically correct way, I believe that the operator should ask questions and go beyond just checking the CE marking, much as he would do in the case of a drug prescription. Who would recommend taking an antibiotic available on the market a few years ago and tested on an insufficient number of patients?
Cost considerations
After these considerations, procedural and ethical, I turn to what may be the cost items for the realisation of an implant-prosthetic restoration. This assessment does not come from the perspective of a marketing expert or an economic expert, but from the pure and simple perspective of a daily operator who must evaluate which elements actually affect daily clinical practice.
It takes into consideration the variable costs and fixed costs. Variable costs change more or less in proportion to changes in the production volume (the insertion of two implants and two crowns costs more than that of only one; paying an assistant for two hours costs less than paying him for eight hours). Fixed costs are defined costs that are not derived from the production volume. Fixed costs in dentistry are all the costs linked with the activity of the practice, such as those related to radiation protection, verification of the electrical system, steril isation, waste disposal, insurance policy, building rental/payments and utilities in general.
The fixed costs are taken into account for any type of service rendered by the practice (Table 1). It is generally believed that a cheaper implant system is needed to save costs (Table 2) regarding implant treatment. From an analysis of the variable costs, it is evident that the costs of the storeroom and of the implant components are significant.
If an implant system entails many surgical steps, requires the use of many drills, has different platforms depending on the diameter of the neck, requires a surgical screwdriver and a prosthetic screwdriver or if different healing abutments are required for each implant placed, the final cost will change significantly, together with an increased risk of errors and inaccuracies (Tables 3 & 4). In particular, if the implant system offers different diameters, each requiring a different healing abutment, a different transfer and a different analogue, the amount of material to be kept in stock will be much higher, considering the prosthetic solution for every case. In terms of the healing abutment, stocking different heights and diameters according to each size available (at least four for the major implant systems) requires dozens of healing abutments even if only a few implants are placed. All this also inevitably leads to mistakes, organisational miscommunication, etc.
If the cover screw and the healing abutment came together with the implant, and therefore already included in the package (and price), things would be much more ergonomic. There would no longer be a need to stock other material or to re-use titanium healing abutments with the inevitable associated risk of inducing peri-implantitis during uncovering.
Costs related to sterile conditions
In a study on the success rates of osseointegration for implants placed under sterile versus clean conditions, Scharf and Tarnow found that the difference in the success rates was not statistically significant.[8] Sterile surgery took place in an operating room setting and followed a strict sterile protocol.
Clean surgery took place in a clinic setting with the critical factor that nothing touched the surface of the implant until it contacted the prepared bone site. The results indicate that implant surgery performed under both sterile and clean conditions can achieve the same high rate of clinical osseointegration. This means that, while it is therefore not essential to incur the costs related to absolute sterile conditions (Table 5), dentists should not undertake surgery without taking adequate precautions in this regard. The modest savings achieved with regard to the total cost of the intervention could lead to a significant increase in the risk of failure.
We have to consider that an insufficiently tested implant system may lead to trivial errors (difficulty in taking an accurate impression, tightening the components, rotation or loosening of the prosthetic components), resulting in an inevitable loss of time, which in turn affects the cost and delivery. What sense does it make to save € 50 on the cost of the implant system when you have to spend as much or more in buying components separately or in seeing the patient several times owing to these trivial errors (considering the hourly rate given above)?
Also, if failure is always a factor to be taken into consideration, it follows that dentists must seek to eliminate predictable and avoidable failures, which are those for which the dentist is partly responsible (the aforementioned poor management of sterility, improper surgical planning, and an incorrect or adequate surgical sequence). Predictable and avoidable failure may not only result in easily quantifiable economic damage, but also lead to important and less easily quantifiable damage in terms of the reputation and credibility of the practice, which could affect the patient’s confidence in the dentist and his willingness to promote the practice.
Conclusion
In conclusion, we should consider the following with regard to cost management in implant surgery:
-paying particular attention to the significant costs;
-simplification and streamlining of clinical and extra-clinical procedures;
-identification of alternative treatments with a different cost–benefit analysis; and
-a schedule for reduction or elimination of errors and significant associated costs.
All this will contribute towards a better understanding, and in a more responsible and ethical way, of when it is really necessary to try a new implant system and by what criteria its actual reliability can be evaluated. What is the true effect of the price of the implant on the total cost for the practice? We should not be misled in selecting an item that does not appear to be of primary importance in terms of absolute cost. A final consideration is the cost in terms of the practice’s reputation, for example in the case of an avoidable failure.
In the light of these considerations, by selecting protocols and materials more rigorously and by giving greater consideration to ethics in our eval uations, we will be able to achieve a real reduction in cost in areas that do not involve interference in the final quality of our work output. We should attempt to save money in areas that affect the final result, with important consequences for us, for our professionalism and for patients who gave us their trust and confidence when entrusting their health to us. Do we have the right to betray their trust, or do we rather have the duty to preserve and respect it?

        

[Author]

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